Md. officials must ensure health care for all, regardless of income

Baltimore, MD-2/7/13 - A patient is wheeled into the emergency room at Bon Secours Hospital. Bon Secours is part of a new "health enterprise zone" in West Baltimore. Amy Davis / Baltimore Sun - #132

Baltimore, MD-2/7/13 - A patient is wheeled into the emergency room at Bon Secours Hospital. Bon Secours is part of a new "health enterprise zone" in West Baltimore. Amy Davis / Baltimore Sun - #132

Darrell J. Gaskin, Roland J. Thorpe Jr., Jamar Slocum

The health care delivery system in Maryland is among the best in the country, with nationally ranked hospitals and an abundance of highly trained health professionals across the state. As such, most Marylanders have access to great health care. However, for some Marylanders our health care system does not work well and access to health care is challenging.

To address this gap, Maryland implemented the Maryland Health Enterprise Zone Initiative in 2013 to meet the health care needs of residents living in low-income and medically underserved communities. This four-year, $16 million project provided funding to establish primary care practices and support care coordination; deploy community health workers and provide an array of public health, social and transportation services that supported medically needy residents in maintaining their health.

The initiative designated five communities across the state as Health Enterprise Zones: Annapolis/Morris Blum, Capitol Heights, Caroline and Dorchester Counties, Greater Lexington Park and West Baltimore.

The Health Enterprise Zone program ran through 2016. At the present time, it does not have state funding, and efforts to revive the program, or ones like it, are floundering.

This is unfortunate, because the program was shown to reduce hospital stays and save money. In a recent study published in the October 2018 edition of Health Affairs, the Johns Hopkins Center for Health Disparities Solutions showed that the implementation of the Health Zone Enterprise Initiative was associated with a significant reduction in inpatient stays and health care costs. The program had an overall reduction of 18,562 inpatient stays over four years. And while emergency department visits did increase by 40,488, their costs were more than offset by the reduction in inpatient stays. The Health Enterprise Zones saved insurers and patients about $108 million. That’s a substantial return on their $16 million outlay for the program.

This was a win-win-win for Maryland, for both providers and patients: The program reduced the overall costs of hospital care. Physicians in these communities felt that they had the resources that helped them better care for their high-need patients. Patients felt empowered and supported in their efforts to maintain their health and importantly felt they had better access to health care.

The key to the success of the initiative is that it enabled health care providers, the local health department and community-based organizations in these communities to address the barriers to care most relevant to their needy residents instead of prescribing a one-size-fits-all solution.

The biggest question is, what do we do now? Despite Maryland’s many health care advantages, the state still has many underserved communities. When the program was introduced in 2013, 19 communities applied for funds under the Health Enterprise Zone Initiative. Only five were funded, and, as of 2016, the program has ended. The five Health Enterprise Zones have tried to sustain their programs, a few with more success than others.

Such programs aimed at improving access to care in underserved communities need to be continued and expanded in order to fully address the health care needs of our most vulnerable residents.

It is our responsibility to encourage our state and local officials to financially support the Health Enterprise Zone Initiative and other programs like it to address barriers to care in under-served communities. What good is having a great health care delivery system if our neediest residents don’t have access to it?

In Maryland, we cannot become complacent simply because we have the best health care system for some. Indeed, a great society ensures access to health care for everyone, even for those individuals who may not have a voice.

Darrell J. Gaskin (dgaskin1@jhu.edu) is the William C. and Nancy F. Richardson Professor in Health Policy and director of the Johns Hopkins Center for Health Disparities Solutions at the Bloomberg School of Public Health; he is also the pastor of Beth Shalom A.M.E. Zion Church in Clinton, Md. Roland J. Thorpe Jr. is associate professor of Health Behavior and Society and deputy director of the Johns Hopkins Center for Health Disparities Solutions at the Bloomberg School of Public Health. Dr. Jamar Slocum is a resident physician in the General Preventative Medicine Residency at Johns Hopkins University. This article is the personal opinion of the authors and is independent of their affiliation with Johns Hopkins University and Dr. Gaskin’s affiliation with the A.M.E Zion Church.

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